With the start of 2016, thousands of Illinois consumers were supposed to receive proof of new health insurance plans from Blue Cross Blue Shield of Illinois, after the insurer cancelled the popular “Blue PPO” individual plan. Many who had to switch to a new plan tell NBC 5 Investigates that 2 weeks into the new year, they have yet to receive that proof and can’t get answers from the state’s largest insurer.
The Passaglia family of St. Charles is among those affected. When 13-year-old daughter Grace got sick last week, the family learned that without proof of their new insurance plan, Grace’s doctor visit would likely not be covered.
"We can't make any appointments, we can't get any treatments, we can't get any test, we can't really do anything because we're considered uninsured," father Tony Passaglia said.
Business owner Mary O’Connor says she’s waiting, too, Neither she, nor her 15 employees have proof of insurance, despite turning in the applications before the deadline. O’Connor says she’s worried about what will happen if anyone gets sick, and is furious with BCBS for its lack of response.
“Nobody from Blue Cross will answer one phone call, one email, one letter. They will not acknowledge you exist,” O’Connor lamented. "If they precipitated this problem, by mass cancellations last fall, they should have planned for crisis management. They are doing nothing for crisis management. There's a million ways they could have solved this,"
Anger at BCBS of Illinois is palpable: consumers online blast the service they’ve received, and the Better Business Bureau currently gives the company “F” rating.
But business owners caught in the lurch say the federal government plays a role here, too—looking the other way when insurers keep cutting programs and creating confusion.
Business owners caught in the lurch say the federal government shares some of the blame, too: allowing insurers to cut programs and to create so much confusion.
Tony Passaglia said he wasn’t going to stand by last week as his daughter was getting sicker but not getting care. He said he marched into the BCBSIL Headquarters in Downers Grove to get answers. But all he got was a police escort off the premises, he said.
"Security guard came up and says I have to ask you to leave the building," he told NBC5 Investigates.
BCBS of Illinois spokesman Michael Deering said he could not estimate how many customers in Illinois are affected, but acknowledged a backlog affecting many customers. In a statement to NBC5 Investigates, Deering said:
We can't comment on specific customers or applicants due to privacy policies, but I can tell you that we've seen unprecedented volume of new small group applications for 2016 insurance coverage. We believe these new groups have applied for coverage due to variety of reasons, including the recent federal decision to keep the definition of a "small group" as 1-50 employees. Obviously, changes this year to what plans insurers offered this year also drove volume, as small group employers shopped around and changed their coverage.
While we anticipated a greater number of small group applications, the volume exceeded our projections, and it's been complicated by the fact that a large portion of submitted applications were sent after the requested effective date. While we’ve added additional staff and increased working hours to address the volume, we still anticipate extended processing time to clear these applications.
Typically, processing times for new group paperwork averages just two weeks or less, but due to the volume of new small group applications, we're anticipating processing times may be extend to up to 30 days or possibly more, though we're doing everything we can to expedite these new customer requests.
For now, we recommend that individuals not terminate their current policy until they've received confirmation of their new coverage from Blue Cross and Blue Shield of Illinois (BCBSIL). The reasoning for this guidance is that until a group has gone through all the application processing steps, and BCBSIL is now able to administer benefits under their new policy, the group's insured status is not yet confirmed.
Until a group is processed an in the system as approved, neither BCBSIL's account executives, brokers and customer service teams cannot verify the group’s benefits and coverage. Therefore, members may be responsible for costs related to prescription drugs, provider or hospital services and
fees.
Once a group is processed and approved however, members may then submit claims forms to be reimbursed for their qualified out-of-pockets costs associated with medical services. Those forms are available through bcbsil.com.
If members have urgent care needs, but have not received member ID cards yet, they may call the hotline phone number, at: 1-800-541-2762. Press “1” at the voice message prompt that says, “If you are calling on a policy with a 1/1/16 effective date and have not received your ID card, press 1.”
